The Deutsche Press Agency reports on the Foundation's partnership with the government of the Kingdom of Lesotho to increase access to HIV/AIDS prevention, care, and treatment services in some the hardest to reach communities in the country.

MOKHOTLONG, LESOTHO - Lesotho's Mokhotlong district epitomizes the landscapes for which the tiny southern African country known as the 'Kingdom in the Sky' is famous.

Steep mountain peaks are dotted with villages, which are accessible only by rough dirt tracks that are impassable during the snowiest months of winter and the rainiest months of summer.

These logistical challenges hamper access to health care in a country already battling the world's third-highest HIV prevalence (23.2 per cent of adults) as well as high levels of maternal/infant mortality and malnutrition rates.

Now, health authorities in Mokhotlong, working in partnership with the US-based Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), have found a solution - one that involved literally rethinking the wheel.

For the past three years, under the Horse-riding for Health programme, Mokhotlong district has been using Basotho ponies to ferry blood samples and medication to and from remote mountain clinics.

These locally-bred animals, which have evolved to handle Lesotho's rough terrain and difficult weather conditions, have a better grip than any 4x4.

'We were looking for a way to reach these remote populations that cannot be reached by car for four months out of the year,' said EGPAF Country Director Leopold Buhendwa.

'We thought, why not try the horse? In the very high mountains, if you want to travel far, the only way is by horse.'

Rather than purchasing ponies for health workers to ride, which would require costly training and maintenance, EGPAF and the health authorities pay local pony owners to carry supplies to and from remote clinics.

Apart from filling a gap in the health system the programme also provides a livelihood for the riders.

Lesotho's unemployment rate hovers around 23 per cent.

'I heard they wanted people to ride horses to the clinics,' said Potso Seoete, a horse-owner from Polomiti village. 'It is good that I am able to assist people who are ill, especially those with HIV who are on ARVs [antiretroviral drugs].'

With the money 30-year-old Seoete earns through the programme, he is able to feed his horse and buy food for his wife and two children. Riders receive 300 Loti (about 42 dollars) per clinic trip.

Several times a week, Seoete leaves home at 7:00 am to make the 30-minute rid along Mokhotlong's main road to Mapholaneng Red Cross Clinic. There, he is given an insulated bag and a delivery of ARVs, if additional ARV supplies are needed.

From that clinic it's more than a three-hour ride to the Molika- liko Health Centre, which sits on a barren plateau over 3,000 metres above sea level.

At Molika-liko, Seoete drops off the ARVs and picks up blood samples taken that morning. Most of the samples have been taken to measure the CD4 counts of patients previously diagnosed with HIV - a measure of how far the virus has progressed and whether the patient should begin taking ARVs.

To yield accurate results, the samples must reach the laboratory at Mokhotlong Hospital within six hours of being drawn.

Seoete rides back to Mapholaneng and hands the bag to a waiting motorbike rider, who then transports the samples to the hospital about 20 kilometres away. The samples reach the laboratory by mid- afternoon.

'The patients' blood gets to the lab sooner so they can get started on treatment sooner,' said Seoete.

Seventeen-year-old Setloboko Nkholise lives in Molika-liko, in a hut next to the clinic. He was diagnosed HIV-positive four years ago and gets the care and treatment he needs through Horse-riding for Health.

'In 2005 I got sick. Sores covered my body,' Nkholise explained as he watched Seoete leave the clinic on his pony. 'I started to take ARVs when I was 14. I feel better now.'

Remote clinics like Molika-liko also serve pregnant women with HIV, who take ARVs to protect their health during pregnancy and to prevent mother-to-child transmission of the virus.

Since the pony express began, health workers have been able to extend mother-to-child transmission and ARV services to all of Mokhotlong's population of nearly 90,000, according to Libuseng Khoanyana, the district clinical coordinator for HIV/AIDS services.

'We are able to test people on time. I really feel that it has helped a lot.'

There are other benefits to roping in horsemen to help diagnose and treat HIV.

'When you have a horse, it means that you are a very important person in the community,' said EGPAF's Leo Buhendwa. 'The fact that the horse-riders are working with us gives more acceptance to the messages about HIV.'

The Horse-riding for Health programme employs four riders in Mokhotlong - one for each clinic not easily accessible by car. EGPAF plans to expand the programme to other regions in the coming year.